What to expect

Throughout your treatment under Shoulder Specialists you will be receive a highly professional, individualised approach to your shoulder issue.

The care you will be given will not end once the treatment is complete. That is why you will receive a follow up survey six months later. What’s more, you will continue to have access to the services for life. The links on this page will give you an idea what to expect during the different phases of your treatment.

Initial consultation / rapid access

Your initial contact with Shoulder Specialists will usually be with our Practice Manager Sue Sollars.

Sue will arrange for you to have an appointment with Mr. Jennings at a time convenient to yourself. If your problem is urgent, Sue will endeavour to find you an appointment as soon as possible.

Investigations can, if necessary, be arranged on an urgent basis.

At the initial appointment with Gavin Jennings, the aim will be to make a diagnosis. Treatment is often commenced at the initial appointment in the form of, for example, a steroid injection. A plan will be formulated for any further investigations or treatment required at that time.

You will receive a copy of the consultation letter describing the initial consultation. This can be sent by email if requested. Your GP or physiotherapist will also receive a copy as appropriate. You will, of course, also receive letters pertaining to any subsequent consultations.

Imaging and diagnostics

There are four main types of imaging used around the shoulder:

X-rays Mainly for assessing the bones of the shoulder e.g. in fractures or arthritis

CT (Computerised Tomography) scanningThis is a special type of X-ray machine which takes multiple images of a part of the body which are then built up into a detailed and accurate picture of the area of interest. CT scans are particularly used to assess the bones of the shoulder girdle, but provide much more detail than X-rays.

Ultrasound This uses high frequency (inaudible) sound waves to form images of the inside of the body. The sound waves reflect off different tissues in different ways and the reflected waves are used to build up a picture.

It is particularly useful for assessing the soft tissues of the body and will also detect areas of inflammation. Ultrasound is also sometimes used to guide, and ensure accurate placement of, injections. It is commonly used to assess the tendons in the shoulder.

MRI (Magnetic Resonance Imaging) This is an advanced form of imaging which gives information on all the structures in the body, but is particularly useful in the assessment of the soft tissues.

The machine consists of a very powerful magnet which produces data which is analysed by the computer to produce incredibly detailed images. Sometimes a special dye is placed into the shoulder joint (this is called an MRA or Magnetic Resonance Arthrogram) to further delineate certain areas of damage. MRA’s are used, for example, to assess the unstable shoulder.

These types of imaging may be used variously for diagnosis; helping plan the treatment of certain conditions; to help plan surgery; to monitor progression of healing; or for guiding injection placement.

There are no real exceptions as to who can have an ultrasound, but the other types of imaging mentioned above, sometimes need to be used with caution, for example on patients in early pregnancy. Suitabilty for each type of imaging is carefully assessed in every case. For more information please see investigations

Circle Bath HospitalCircle Bath has excellent radiology provision with a 1.5T GE MRI scanner, GE ultrasound and CT scanners, an X-ray room and a dedicated fluoroscopy room. Images are stored and reviewed on a McKesson PACS system, which is linked, where necessary, to the national Information Exchange Portal (IEP). This means that images can be transferred to and from other units in the UK (useful if you have had a scan elsewhere)

The right treatment here

The appropriate treatment for you will depend not only on the condition, but also you as an individual, including your own aspirations.

Although Mr. Jennings is a surgeon, this does not mean that surgery is always the answer to your shoulder problem. In many instances surgery can, and should, be avoided. Other forms of treatment include steroid injections, specialist physiotherapy, and nerve block

If surgery is planned, this will be explained in detail including the aims, risks and likely outcomes.

Usually surgery can be performed arthroscopically but some operations need to be performed “open” i.e. with an incision e.g. joint replacement surgery.

Throughout your treatment you will be fully informed of, and fully involved in, the decision making process.

Recovery and rehab

The exact recovery and rehabilitation following surgery will be individualised, however the following serves as a general guideline:

Guidelines for after surgery

Hospital stay

Many keyhole operations are performed as day-case procedures. However, some patients may prefer to stay overnight for these; for other procedures it may be advised that you do so.

It is rare to need to stay for more than one night, but for a few procedures such as joint replacement, a two night stay is not uncommon.

Pain relief

Patients will usually be offered a nerve block which will be performed by the anaesthetist immediately prior to the anaesthetic. This should provide good pain relief for the first 24 to 48 hours after surgery. Once the block wears off there will usually be some discomfort. This can be minimised by taking the pain killing tablets you will be given, prior to the block completely wearing off. You may also be advised to use a cold compress in the first few days after surgery.

Wounds

If you have keyhole surgery the wounds will be minimal. Each of the two or three small cuts will have a single stitch and a small plaster dressing over each. These stitches are usually removed 8 to 12 days after the operation. This is normally done by the practice nurse at your GP surgery. This will be arranged by the hospital ward staff prior to your discharge.

If you have open surgery with a larger incision, the wound will usually be closed with a subcuticular stitch. This means that the scar will usually be a neat thin line. The ends of the stitch are cut flush with the skin at about 12 to 14 days after the operation.
You will be given advice on washing etc. and other aspects of wound care prior to stitch removal.

Immobilisation

After the majority of operations you will be in a sling. The period of immobilisation and the restrictions vary dependent on the procedure. The following are the average periods for some of the more common operations.

Operation

Time in sling

Frozen shoulder release

1 to 2 days

Subacromial decompression, AC joint excision

3 to 5 days

Stabilisation surgery (Bankart, Latarjet), SLAP repair

2 to 3 weeks

Clavicle or Humeral fixation, AC reconstruction

3 to 4 weeks

Rotator cuff repair, Joint replacement

4 to 6 weeks

Driving

Again, the return to driving varies significantly. You will be advised prior to the operation of the likely period over which driving will need to be avoided.

As a general guideline, this period is likely to be slightly longer than the period in a sling (see above) but usually with a minimum period of one week.

Work

This again depends not only on the type of operation, but also on the type of work that you do. The need to drive to, and for work, may also be an influence. You will again be advised, prior to the operation, of the likely time needed off work and whether you may be able to return earlier on modified duties. In general, if your work is physical you are more likely to need longer off than those in desk / office type employment.

Review

You will always be seen in clinic following any operation. The initial follow up appointment will be made for you by the practice manager for about three weeks after the operation. You will be provided with contact numbers to arrange earlier follow up if you feel you need to be seen sooner.

Rehabilitation

You will usually be guided in your rehab by an experienced physiotherapist. You may have been referred for treatment by your own physiotherapist and it is usual to return that practitioner for post-operative rehabilitation. If you do not have a specific physiotherapist we will recommend a physio with the suitable expertise. There is an excellent physiotherapy service at the hospital, but you may prefer to see someone nearer home or nearer your workplace. One of the hospital based physiotherapists will see you prior to discharge after your operation. This physiotherapist will ensure that a plan is in place for your out-patient physio and will liaise with the selected practitioner to ensure he / she is provided with details of the operation and your individualised rehab programme.